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FACT SHEET HYPERTENSION IN CANADA HIGH BLOOD PRESSURE (HYPERTENSION) IS THE LEADING HYPERTENSION CREATES HIGH ECONOMIC COSTS FOR RISK FOR DEATH AND DISABILITY WORLDWIDE INDIVIDUALS AND SOCIETY Hypertension accounts for over 20 million physician Globally, hypertension causes an estimated 19% of deaths (9.4 million annually) and 7% of disability (1). Hypertension is responsible for up to 50% of deaths due to heart disease and stroke and is a leading cause of kidney disease and kidney failure (1-3). An estimated 40% of adults over the age of 25 have hypertension (3). Decreasing population systolic blood pressure by 5 mm Hg could reduce stroke deaths by 14%, coronary heart disease by 9% and premature death by 7% (3,4). Reducing uncontrolled blood pressure 25% by 2025 is a global health target agreed to at the World Health Assembly. (3) visits annually (11). In 2014, there were over 85,000,000 antihypertensive drug prescriptions at a cost of $2 billion (6). Overall, hypertension cost over 13 billion dollars in 2010 and the costs estimated to increase to 20 billion dollars annually by 2020 (12). REDUCING MODIFIABLE RISK FACTORS CAN HELP PREVENT AND CONTROL HYPERTENSION FOR MOST INDIVIDUALS Hypertension is associated with an unhealthy diet, particularly high dietary sodium. High sodium intake causes an estimated 32% of all hypertension (Table 1). Current national guidelines recommend consuming no more than 2300mg of sodium per day (13). Other modifiable risk factors include excess body fat, low dietary potassium (low fruit and vegetable intake), physical inactivity and high alcohol intake (Table 1). AN ESTIMATED 7.5 MILLION CANADIANS HAVE 2016 May HYPERTENSION High blood pressure is among the top risk factors for death, disability adjusted life years (DALYs) and years of life lost (YLL) in Canada (1). The prevalence of hypertension in adults is 22.6%. An additional 20% have prehypertension (5,6). Hypertension prevalence increases with age from less than 10% among adults 20 - 44 years old to more than 70% among adults over 80 years old (7). Over 90% of Canadians are estimated to develop hypertension if they live an average life span (8). TABLE 1: LIFESTYLE CAUSES OF INCREASED BLOOD PRESSURE LIFESTYLE FACTOR High dietary sodium intake ATTRIBUTABLE RISK FOR HYPERTENSION, % 32 Obesity 32 Low dietary potassium intake 17 Low physical activity 17 CERTAIN DEMOGRAPHIC GROUPS ARE AT HIGHER RISK FOR High alcohol intake 3 HYPERTENSION Canadians who are Aboriginal, of South Asian Source: National Academy of Sciences, 2011 and black ethnicity, and individuals with low socio-economic status are at greater risk for developing hypertension (9). People living in the territories are less likely to be treated when they are diagnosed. Older women are less likely to achieve blood pressure control (10). Young males with hypertension are less likely to be aware and therefore less likely to have their hypertension treated and controlled (10). Most with hypertension, have other treatable health risks that are not optimally controlled. SOME GOOD NEWS Canada has the world’s highest reported national rates of hypertension awareness, treatment and control. (5,6) PUBLIC POLICIES ARE RECOMMENDED FOR THE PREVENTION AND CONTROL OF HYPERTENSION IN CANADA Sodium reduction interventions at a population level have been shown repeatedly to be cost saving, effective and efficient for early cardiovascular disease prevention (14). Blood pressure education and screening are costeffective for identifying adults at increased risk for cardiovascular disease due to high blood pressure (15). About this Publication: This fact sheet is a product of the HSFC/CIHR Chair in Hypertension Prevention and Control and Hypertension Canada and is intended for information and policy guidance purposes. For more information and to download visit: www.hypertensiontalk.com and www.hypertension.ca Box 1: PAN-CANADIAN HYPERTENSION FRAMEWORK HYPERTENSION PREVENTION AND CONTROL OPPORTUNITIES FOR CANADA Federal, Provincial and Territorial Governments Collaborate to operationalize the Pan Canadian Framework on the Prevention and Control of Hypertension (Box 1). Fund, prioritize and implement population based policies that target hypertension risk factors (diet, tobacco, alcohol, physical activity). Recommended strategies include sodium reduction, restricting food and beverage marketing directed at children, healthy food procurement in public and private settings, reducing financial conflicts of interest with food processing companies, front-of-package nutrition labeling, enhancing research and monitoring of the food supply, and taxation and subsidy schemes (16, 17). Strengthen hypertension surveillance and monitoring to include vulnerable populations. Fund implementation of the Hypertension Canada Guidelines for the screening, diagnosis, treatment and management of cardiovascular diseases that includes hypertension. Fund implementation of evidence-based community and workplace hypertension awareness, screening and management programs. Health and Scientific Organizations Integrate elements of the Pan Canadian Hypertension Framework into organizational policies and programs in ways that support healthy eating environments. Urge federal government adoption of population based strategies that address hypertension risk factors. REFERENCES 1) Institute for Health Metrics and Evaluation. Global Burden of Disease Arrow Diagram. Retrieved from: http://www.healthmetricsandevaluation.org/gbd/visualizations/ gbd-arrow-diagram 2) Udani S, Lazich I, Bakris GL. Epidemiology of hypertensive kidney disease. Nat Rev Nephrol. 2011 Jan;7(1):11-21. 3) World Health Organization. A global brief on hypertension: silent killer, global public health crisis. World Health Day 2013. Report , 1-39. 2013. Geneva, Switzerland, World Health Organization. 4) Whelton P, He J, Appel L, et al. National High Blood Pressure Education Program Coordinating Committee. Primary prevention of hypertension: Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 2002;288:1882-1888 5) Wilkins K, Campbell N, Joffres M, McAllister F, Marianne N, Quach S, et al. Blood pressure in Canadian adults. Health Reports. 2010;21(1):1–10 6) Padwal RS, Bienek A, McAlister FA, Campbell NRC for the Outcomes Research Task Force of the Canadian Hypertension Education Program. Epidemiology of Hypertension in Canada: an Update. Can J Cardiol. 2015 DOI: http://dx.doi.org/10.1016/j.cjca.2015.07.734 A STRATEGIC APPROACH TO SAVE LIVES, IMPROVE QUALITY OF LIFE AND REDUCE HEALTH CARE COSTS UPDATED 2015 http://www.hypertensiontalk.co m/canadian_hypertension_frame work/ Vision: The people of Canada have the healthiest blood pressure distribution, lowest prevalence of hypertension and the highest rates of awareness, treatment and control in the world. 7) Public Health Agency of Canada. Report from the Canadian Chronic Disease Surveillance System: Hypertension in Canada, 2010. Retrieved from: http://www.phac-aspc.gc.ca/cd-mc/cvdmcv/ccdss-snsmc-2010/2-2-eng.php 8) Vasan RS, Beiser A, Seshadri S, et al. Residual lifetime risk for developing hypertension in middle-aged women and men. JAMA 2002;287:1003-10 9) Campbell N, Young E, Drouin D et al. A framework for discussion on how to improve prevention, management and control of hypertension in Canada. Can J Cardiol. 2012;28:262-69 10) Campbell NR, McAlister FA, Quan H. Monitoring and evaluating efforts to control hypertension in Canada: why, how, and what it tells us needs to be done about current care gaps. Can J Cardiol. 2012 Jul 16 11) Hemmelgarn BR, Chen G, Walker R et al. Trends in antihypertensive drug prescriptions and physician visits in Canada between 1996 and 2006. Can J Cardiol. 2008;24:507-12 12) Weaver CG, Clement F, Campbell N et al. Health Care Costs Attributable to Hypertension: a Canadian Population-Based Cohort Study. Hypertension. 2015;66:00-00. DOI: 10.1161/HYPERTENSIONAHA.115.05702 13. Health Canada. Sodium Reduction Strategy for Canada. Retrieved from: http://www.hc-sc.gc.ca/fn-an/nutrition/sodium/relatedinfo-connexe/strateg/reduct-strat-eng.php 14) Wang G, Labarthe D. The cost-effectiveness of interventions designed to reduce sodium intake. J Hypertens. 2011;29(9):16939 15) Howard K, White S, Salkeld G, et al. Cost effectiveness of screening and optimal management for diabetes, hypertension, and chronic kidney disease: A modeled analysis. Value Health. 2010 Mar;13(2):196-208. 16) Mozaffarian D, Afshin A, Benowitz NL et al. Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement from the American Heart Association. Circulation. 2012; 126 (12): 1514-63-68 17) Campbell N, Willis KJ, Arthur G, Jeffery B, Robertson HL, Lorenzetti DL. Federal government food policy committees and the financial interests of the food sector. Open Medicine. 2013;4:107-11. About this Publication: This fact sheet is a product of the HSFC/CIHR Chair in Hypertension Prevention and Control and Hypertension Canada and is intended for information and policy guidance purposes. For more information and to download visit: www.hypertensiontalk.com and www.hypertension.ca